An analysis of closed cases from 2001 to 2010 shows that five per cent of all college cases, and five per cent of all hospital complaints cases, now involve 'disruptive behavior' by doctors, according to a new CMPA discussion paper.

They berate, bully, belittle and sometimes even throw medical instruments.

Now, new concerns are being raised about doctors in Canada behaving badly.

According to the Canadian Medical Protective Association (CMPA), the powerful body that defends doctors accused of malpractice, the number of cases is growing involving doctors facing allegations of unruly behaviour by their licensing colleges or hospitals.

An analysis of closed cases from 2001 to 2010 shows that five per cent of all college cases, and five per cent of all hospital complaints cases, now involve “disruptive behavior” by doctors, according to a new CMPA discussion paper.

The majority of the cases, the organization warns, had an “unfavourable outcome” for the doctor.

“While unprofessional conduct by physicians was never acceptable, it is clearly no longer tolerated in today’s healthcare environment,” the paper states. “In the long-term, disruptive behaviour can lead to ineffective care, harm to patients and poorer clinical outcomes.”

“Physician disruptive behaviour” isn’t a one-off, or “single, egregious” act, the doctors’ liability insurer says. Rather, it’s a enduring pattern of offensive behaviour that poisons morale and potentially harms patients. If a doctor chronically ignores pages, for example, or gets abusive if called at night, nurses and colleagues might be reluctant to report a change in a patient’s condition and instead wait for the next doctor to come on duty, delaying treatment.

Studies suggest up to six per cent of doctors engage in recurrent disruptive behaviour, says Dr. James Sproule, managing director of physician services at the CMPA.

The number is small, but significant, and throws a poor light on the entire profession, he said.

Sometimes the offensive behaviour is overt: bullying, yelling and swearing; throwing things and demeaning people in front of others; and uncontrolled outbursts of anger that can leave people feeling constantly on edge.

Other times it’s more passive-aggressive: not responding to pages or emails; skipping meetings and “not behaving as part of the team,” Sproule said.

In one U.S. study, 77 per cent of doctors surveyed in 2011 said they were concerned about badly behaving doctors at their hospitals. What’s more, “An overwhelming 99 per cent of doctors believe that disruptive behaviour affects patient care,” the CMPA paper says.

Sproule’s analysis of closed CMPA cases shows clearly that “we’ve seen increasing number of cases, and increasing medical-legal costs associated with” doctors behaving badly. Complaints come from not just co-workers and hospital staff, but also patients and their families.

Sproule didn’t break the disruptive doctor files down by gender. “But the literature is clear on that: it’s generally males,” he said, and most often male doctors working in high-stress, high-tension areas, such as surgery, emergency medicine, intensive care and obstetrics.

Stress, burnout, cynicism, frustration over health-care cuts and other triggers can exacerbate the problem. According to the College of Physicians and Surgeons of Alberta’s 2010 document on managing disruptive behaviour in the health-care workplace, 78 per cent of doctors displaying disruptive behaviour may suffer from a major psychiatric disorder; up to 40 per cent may suffer from depression.

And while the unruly behaviour can compromise patient safety, studies from the United States suggest that many doctors have kept quiet rather than confront a “known intimidator.” Colleagues might ignore them, or work around them.

Some doctors lack any kind of insight into the impact of their behaviour, experts say. Many are highly skilled, even “champions for their patients,” Dr. Paul Farnan, an occupational health consultant based in Vancouver, said at a special session on disruptive doctors at the CMPA’s annual meeting in August. “They want to be perfect, they want to get everything right, and someone is saying, ‘No, you can’t have that CAT scan or you can’t get into the OR right now’ and this can be devastating for these folks.”

Part of it may be due to the personality types drawn to medicine. Many doctors are high-performing, high-achieving perfectionists, Sproule said. “They have such high expectations of themselves, they can’t accept anything but the best from everyone else.”

At the end of the day, “the buck always stops with the doc,” Farnan said in an interview.

“So, when things are going sideways, and the baby’s not being delivered right, or the guy’s heart attack is not going right, at the end of the day the lawsuit, or the trouble, will usually end up on the doctor’s shoulders,” Farnan said. “Traditionally, they’ve been the ones who have had to take control of situations, and take responsibility.”

Doctors don’t hold a monopoly on bad behaviour. “Studies show that, if you ask people in the health system, ‘Who have you seen acting badly?’ doctors come first, nurses are a close second and administration is involved as well,” Sproule said.

Sproule says there’s no evidence to suggest there are more doctors behaving badly today than there were 10 years ago.

Instead, “what’s clearly happened is that it’s not tolerated as much – and it shouldn’t be – and it’s being reported more often.”

The goal is to intervene early and not “sweep it under the carpet,” Sproule said. Legislation exists in virtually every province obligating institutions “to pay attention to this” and before the behaviour gets to the stage where a doctor is facing a licence suspension or other serious sanction. Provincial medical organizations can help rehabilitate doctors through their physician health programs.

Studies have shown that the majority of doctors with disruptive behaviours can change, “simply by being made aware of the impact of their behaviour, and then given some coaching,” Sproule said.

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An analysis of closed cases from 2001 to 2010 shows that five per cent of all college cases, and five per cent of all hospital complaints cases, now involve 'disruptive behavior' by doctors, according to a new CMPA discussion paper.

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